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Do I Still Have a Case if Health Insurance Pays My Medical Bills?

April 3, 2022 Personal Injury Lawyers

All sorts of expenses arise as the result of a personal injury. When there is a person or entity responsible for that injury, you do have the right to seek damages in a court of law. One question many people have relates to health insurance and the amount of expenses that the insurance provider covers. Does the injured party still have a case if the insurance company paid all the medical expenses? The answer is yes, but the particulars of the case will be a little different.

What Types of Damages Can Be Claimed?

As part of the suit, your attorney will still want to include every medical expense that you incurred. That figure should reflect the total expense, not just what you paid out of pocket. To arrive at that figure, it’s necessary to combine what you personally paid and what the insurance company extended in the way of benefits.

You will also want to include any other expenses related to your injury. For example, if you were out of work and unable to earn an income for a few weeks or months, the amount of that lost income should definitely be part of your suit. Any provisions for pain and suffering, mental anguish, or other expenses that you incurred because of the accident can also be included.

If you are not sure if an expense is likely to be accepted by the court, talk it over with your attorney. The legal counsel will know what sort of costs can be reasonably related to the injury and the recovery period. It’s in your best interest to include any expense that you can properly document, even the ones that come to only a few dollars.

The Medical Expenses and Your Insurance Company

Including all of your medical expenses, including what the insurance provider has settled, does mean that they will want to recover the amount. In order to accomplish that, expect the insurance provider to file a lien against the lawsuit. This is not a punitive measure on the part of the provider. It’s simply a way to ensure that if you do win the case and the court approves of all damages you seek, the provider is reimbursed.

For example, assume you are injured on private property and must be rushed to the hospital. Since you have health insurance, claims for the services rendered are filed. You pay any deductibles and copays associated with your stay in the hospital, surgery, physical therapy, and medications needed during your recovery. When it’s all said and done, the total medical costs paid by the insurance provider are $60,000. That does not include what you paid out of pocket.

At the time you file your suit, you include any expenses that current laws allow. In total, your suit is for $100,000. The court decides in your favor and the plaintiff is ordered to pay the full amount. With the provider’s lien in place, $60,000.00 of that $100,000.00 will be forwarded directly to the insurance company.

What About the Out of Pocket Medical Expenses?

The court will take into account whatever medical expenses you paid out of pocket. Those expenses are not included in the lien amount claimed by the insurance provider. All the provider wants is reimbursement for the portion of your medical bills that were paid in accordance with the terms of the policy.

That means if the court does decide in your favor, every out of pocket medical expense that you included in the suit will be included in the portion that you receive. Keep in mind that you must include those expenses in your original suit. It’s highly unlikely for a judge to allow you to introduce additional expenses once while the court is determining a verdict.

Who Covers the Legal Fees and Court Costs?

Many attorneys take personal injury cases on a contingency basis. That is, the legal counsel agrees to only receive payment if there is a judgment in favor of the client. If the court chooses to dismiss the suit for any reason, no legal fees are assessed.

If the court does rule in favor of the client, the attorney fees are likely to come out of the awarded amount. The defendant is likely to be responsible for any court costs.

One way to deal with the legal costs is to structure the suit so there are grounds for the court to order the defendant to also pay all attorney fees. Whether this is possible depends on the laws that apply to the court of jurisdiction. Your attorney can discuss this approach with you and outline if and how seeking this type of arrangement would work in your area.

Considering how to cover the legal costs is important to the client. Once the lien placed by the insurance company is satisfied and the legal fees are subtracted from the final award, there may not be much left for the injured party. If it is possible to petition the court to have those fees paid by the defendant, the funds remaining after the insurance company is reimbursed will be more likely to cover all of your out of pocket expenses related to the injury and the recovery.

Remember that settling the matter before it goes to court is always an option. Should the responsible party approach you about a settlement, it never hurts to work with your attorney and determine if an equitable arrangement can be made. Remember to include any portion of your medical expenses that your insurance provider paid as well as your out of pocket costs. Also include your legal fees as part of the settlement. Doing so increases the odds of recovering most if not all of your lost wages and other expenses.

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